Objective:To explore the short-term clinical effects of deep cervical lymph node-venous anastomosis in the treatment of Alzheimer’s disease (AD).Methods:A prospective exploratory study was conducted on the treatment of AD patients using the cervical deep lymph node-venous anastomosis technique in Scar and Wound Treatment Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from September to October 2024. The patients underwent high-frequency ultrasound to locate deep cervical lymph nodes and the external jugular vein. Under general anesthesia, bilateral deep cervical lymph node-venous anastomoses were performed. Indocyanine green (ICG) lymphography was conducted via subcutaneous injection behind the ear to visualize lymph nodes in levels Ⅱ and Ⅲ. After making a skin incision along the posterior margin of the sternocleidomastoid muscle, the external jugular vein, internal jugular veins, and associated lymph nodes were exposed. Adjacent veins were selected for anastomosis of lymph node. Using microsurgical techniques, end-to-side or end-to-end anastomosis was completed for lymph nodes in levels Ⅱ and Ⅲ. Preoperative assessments included the mini-mental state examination (MMSE, a higher score indicates better cognitive function), Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog, a higher score indicates greater impairment of cognitive function), Alzheimer’s disease cooperative study scale for activities of daily living (ADCS-ADL, a higher score indicates better ability to perform daily activity), and neuropsychiatric inventory (NPI, a higher score indicates more severe behavioral and emotional symptom). Postoperative follow-up included the same scales to observe changes in cognitive function, activities of daily living, and emotional communication.Results:Four patients (1 male, 3 females, aged 58-79 years) with AD were included. All were diagnosed based on cerebrospinal fluid biomarkers. All patients successfully underwent bilateral deep cervical lymph node-venous anastomoses. On average, 4.3 (2-7 per person) anastomoses were performed per patient. Surgical procedures lasted an average of 6.5 h (5.5-8.5 h) with minimal blood loss (less than 50 ml). Patients resumed normal activity within 6 hours postoperatively and were discharged after an average of 4.1 d (3.5-5.0 d). Postoperative complications included one case each of aspiration pneumonia, lower limb venous thrombosis, and transient delirium, all of whom resolved without long-term effects. Clinical symptoms, including memory decline, mood swings, and anxiety, showed varying degrees of improvement. Patients reported enhanced quality of life, emotional stability, and social engagement, confirming the procedure’s safety and potential cognitive benefits. At one month postoperatively, the MMSE scores of the four patients increased by an average of 0.8 points compared to preoperative levels. Additionally, the two patients who completed the ADAS-Cog assessments showed a decrease in their scores (reduced by 1.0 points and 11.3 points, respectively, compared to preoperative scores), indicating a certain degree of improvement in cognitive function during this period. The ADCS-ADL and NPI scores of four patients varied significantly, without showing any clear pattern.Conclusion:Lymphovenous anastomosis of the deep cervical lymph node-venous anastomosis may provide a new surgical intervention approach for AD, but further large-scale studies and long-term follow-up are needed to validate its safety and effectiveness.

Objective:To explore the short-term clinical effects of deep cervical lymph node-venous anastomosis in the treatment of Alzheimer’s disease (AD).Methods:A prospective exploratory study was conducted on the treatment of AD patients using the cervical deep lymph node-venous anastomosis technique in Scar and Wound Treatment Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from September to October 2024. The patients underwent high-frequency ultrasound to locate deep cervical lymph nodes and the external jugular vein. Under general anesthesia, bilateral deep cervical lymph node-venous anastomoses were performed. Indocyanine green (ICG) lymphography was conducted via subcutaneous injection behind the ear to visualize lymph nodes in levels Ⅱ and Ⅲ. After making a skin incision along the posterior margin of the sternocleidomastoid muscle, the external jugular vein, internal jugular veins, and associated lymph nodes were exposed. Adjacent veins were selected for anastomosis of lymph node. Using microsurgical techniques, end-to-side or end-to-end anastomosis was completed for lymph nodes in levels Ⅱ and Ⅲ. Preoperative assessments included the mini-mental state examination (MMSE, a higher score indicates better cognitive function), Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog, a higher score indicates greater impairment of cognitive function), Alzheimer’s disease cooperative study scale for activities of daily living (ADCS-ADL, a higher score indicates better ability to perform daily activity), and neuropsychiatric inventory (NPI, a higher score indicates more severe behavioral and emotional symptom). Postoperative follow-up included the same scales to observe changes in cognitive function, activities of daily living, and emotional communication.Results:Four patients (1 male, 3 females, aged 58-79 years) with AD were included. All were diagnosed based on cerebrospinal fluid biomarkers. All patients successfully underwent bilateral deep cervical lymph node-venous anastomoses. On average, 4.3 (2-7 per person) anastomoses were performed per patient. Surgical procedures lasted an average of 6.5 h (5.5-8.5 h) with minimal blood loss (less than 50 ml). Patients resumed normal activity within 6 hours postoperatively and were discharged after an average of 4.1 d (3.5-5.0 d). Postoperative complications included one case each of aspiration pneumonia, lower limb venous thrombosis, and transient delirium, all of whom resolved without long-term effects. Clinical symptoms, including memory decline, mood swings, and anxiety, showed varying degrees of improvement. Patients reported enhanced quality of life, emotional stability, and social engagement, confirming the procedure’s safety and potential cognitive benefits. At one month postoperatively, the MMSE scores of the four patients increased by an average of 0.8 points compared to preoperative levels. Additionally, the two patients who completed the ADAS-Cog assessments showed a decrease in their scores (reduced by 1.0 points and 11.3 points, respectively, compared to preoperative scores), indicating a certain degree of improvement in cognitive function during this period. The ADCS-ADL and NPI scores of four patients varied significantly, without showing any clear pattern.Conclusion:Lymphovenous anastomosis of the deep cervical lymph node-venous anastomosis may provide a new surgical intervention approach for AD, but further large-scale studies and long-term follow-up are needed to validate its safety and effectiveness.

Diabetic nephropathy is a common microvascular complication of diabetes mellitus and one of the main causes of death in patients with diabetes mellitus. Ferroptosis is a newly discovered iron-dependent regulated cell death, which may contribute to the pathogenesis and development of diabetic nephropathy. Adenosine monophosphate-activated protein kinase (AMPK)-mediated ferroptosis-related signaling pathways can slow down the progression of diabetic nephropathy, but excessive activation of AMPK signaling pathway may induce cells to undergo autophagic death. Activation of the signaling pathway mediated by nuclear factor-erythroid 2-related factor (Nrf) 2 and heme oxygenase (HO)-1 can inhibit ferroptosis of cells and alleviate diabetic nephropathy. However, the regulatory effect of HO-1 on ferroptosis is bidirectional, and activation of HIF-1α/HO-1 pathway may lead to intracellular iron overload and ultimately promote ferroptosis. Transforming growth factor (TGF)-β1 mediated signaling pathways can accelerate lipid peroxidation by down-regulating the levels of SLC7A11/GSH/GPX4. The ferroptosis-related signaling pathways mediated by exosome lncRNAs/circRNAs/miRNAs are also involved in the pathogenesis and development of diabetic nephropathy. In addition, signaling pathways mediated by stimulator of interferon gene (STING) and the novel ferroptosis promoter acyl-CoA synthetase long-chain family (ACSL) 1 can induce ferroptosis to promote the progression of diabetic nephropathy. In this review, we focus on the roles of ferroptosis in diabetic nephropathy through the signaling pathways mediated by AMPK, Nrf2/HO-1, TGF-β and exosomes, to elaborate the pathogenesis and development of diabetic nephropathy, and the potential therapeutic target for diabetic nephropathy.
Diabetic Nephropathies/etiology* ; Ferroptosis ; Humans ; Signal Transduction ; Heme Oxygenase-1/genetics* ; NF-E2-Related Factor 2/metabolism* ; AMP-Activated Protein Kinases/metabolism* ; Transforming Growth Factor beta1/metabolism* ; MicroRNAs/metabolism* ; RNA, Long Noncoding/genetics* ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism* ; Lipid Peroxidation ; Animals

BACKGROUND:Congenital clubfoot mainly manifests as abnormal bone itself and abnormal cartilage development.The bone morphogenetic protein(BMP)/drosophila mothers against decapentaplegic protein(Smad)signaling pathway can direct the development of bone and cartilage during embryonic period,but its role in the field of clubfoot etiology has not been confirmed in animal experiments. OBJECTIVE:To explore the mechanism by which the BMP/Smad signaling pathway is involved in the regulation of foot and ankle chondroplasia in a rat congenital clubfoot model. METHODS:Sprague-Dawley rats at 10 days of gestation with the same growth condition were randomly divided into experimental and control groups.The experimental group was intragastrically given 135 mg/kg retinoic acid to make the clubfoot model,while the control group was given the same amount of vegetable oil.The fetal rats were taken out after 21 days of gestation by cesarean section.In the experimental group,the 27 of 41 fetal rats had clubfoot,with a deformity rate of 65.9%;in the control group,no clubfoot was observed in all the 36 fetuses.The ankles tissues of the rats were collected for hematoxylin-eosin staining.Western blot assay,RT-qPCR and immunohistochemistry were performed to detect the expression levels of Smad5 and P-Smad5,the core proteins of the BMP/Smad signaling pathway,as well as SP7 and Sox9,the downstream proteins of the BMP/Smad signaling pathway. RESULTS AND CONCLUSION:Compared with the control group,hematoxylin-eosin staining showed that the cartilage matrix in the foot and ankle tissues increased and the gap between the bones increased in the experimental group.Immunohistochemical findings showed that the expression levels of Smad5 and SP7 decreased in the experimental group,while the mRNA expression of Sox9 increased.RT-qPCR results showed that the mRNA expression of Smad5 and SP7 decreased,while the mRNA expression of Sox9 increased in the foot and ankle tissues of rats in the experimental group.Western blot results showed that P-Smad5/Smad5 expression and SP7 expression were decreased and Sox9 expression was increased in the ankle of rats in the experimental group.To conclude,the occurrence of cartilage abnormalities in the foot and ankle of the rat model of congenital clubfoot is associated with impaired transmission of the BMP/Smad signaling pathway.

BACKGROUND:The development of steroid-induced osteonecrosis of the femoral head is a complex process involving multiple mechanisms.There is still no standard therapeutic drug for early intervention of this disease.Current studies have shown that baicalein has various pharmacological activities such as regulating lipid metabolism,bone metabolism,apoptosis and anti-oxidative stress,which provides an idea for the prevention and treatment of steroid-induced osteonecrosis of the femoral head. OBJECTIVE:To observe the preventive effect of baicalein against steroid-induced osteonecrosis of the femoral head and to investigate its possible mechanism. METHODS:Thirty-six 10-week-old male Sprague-Dawley rats were randomly divided into three groups(n=12 per group):blank control group,model group,and baicalein intervention group.In the model group and baicalein intervention group,intraperitoneal lipopolysaccharide and intramuscular injection of methylprednisolone sodium succinate were performed for modeling,while normal saline was used as a substitute for the modeling drug in the blank control group.Baicalein 300 mg/kg was administered by gavage(once a day for 6 weeks)at the time of initial intramuscular glucocorticoid injection in the baicalein intervention group,and baicalein was replaced by normal saline in the other two groups.The serum level of malondialdehyde in rats was detected at 2 weeks of the experiment.Blood lipid indicators and bone formation metabolic markers were detected at 6 weeks of the experiment,the histomorphometric changes of the femoral head were analyzed by hematoxylin-eosin staining,anti-tartaric acid phosphatase staining and TUNEL staining,and the femoral head was subjected to Micro-CT scanning and three-dimensional reconstruction of the bone in order to analyze the alterations of bone tissue structure and parameters. RESULTS AND CONCLUSION:The serum levels of malondialdehyde,triglyceride,β-collagen type Ⅰ carboxy-terminal peptide were increased and the serum levels of bone specific alkaline phosphatase and pre-collagen type Ⅰ amino-terminal peptide were decreased in the model group compared with the blank control group(P＜0.05).The serum level of malondialdehyde decreased in the baicalein intervention group compared with the model group(P＜0.05),but there was no significant difference between the baicalein intervention group and blank control group(P＞0.05).The serum level of triglyceride was higher in the baicalein intervention group than the blank control group(P＜0.05),but had no significant difference between the baicalein intervention group and model group(P＞0.05).There were also no significant differences in the levels of bone specific alkaline phosphatase and β-collagen type Ⅰ carboxy-terminal peptide between the baicalein intervention group and the other two groups(P＞0.05).The serum level of the baicalein intervention group was lower in the baicalein intervention group than the blank control group(P＜0.05)but had no significant difference between the baicalein intervention group and model group(P＞0.05).Histomorphological analysis of the femoral head showed that the rate of bone empty lacuna,osteoclast counting and cell apoptosis rate in the femoral head of model group rats were significantly higher than those of the other two groups(P＜0.05).There was a significant increase in the number of adipocytes in the bone marrow cavity of the femoral head,bone trabeculae were thinned and sparsely arranged with more disruptions in the continuity.The incidence of osteonecrosis was higher in the model group(75%)than in the baicalein intervention group(25%;bilateral and unilateral exact significance results were both 0.05).There was also an increase in the number of adipocytes in the bone marrow cavity of the femoral head in the baicalein intervention group,and the trabecular changes were roughly similar to those in the model group.Micro-CT results showed that bone volume fraction,trabecular thickness,trabecular number,and bone mineral density decreased and trabecular separation increased in the model group compared with the blank control group(P＜0.05).Overall significant bone mass loss was observed in the model group.Bone tissue parameters in the baicalein intervention group were significantly improved than those in the model group,which were reflected in bone volume fraction,trabecular thickness and trabecular separation(P＜0.05),and trabecular number and bone mineral density had no significant difference between the baicalein intervention group and blank control group(P＞0.05).Although baicalein failed to significantly ameliorate dyslipidemia and promote bone formation in rats with steroid-induced osteonecrosis of the femoral head,it could reduce the incidence of steroid-induced osteonecrosis of the femoral head by reducing oxidative stress damage,decreasing cell apoptosis,inhibiting osteoclasts,suggesting its effectiveness in the early prevention of steroid-induced osteonecrosis of the femoral head.

Objective:To analyze the impact of global budget on the medical flow treatment and fund allocation in a non-compact medical community based on the symbiosis theory, so as to provide references for relevant authorities to formulate policies for the medical community.Methods:Data on outpatient and emergency visits, discharges, and medical insurance fund usage of the leading hospital and primary medical and health institutions in a non-compact medical community were collected from the health information system of a certain city. The time range of the data spanned from January 2017 to December 2019. The total budget was implemented in April 2018. The symbiotic system of the non-compact medical community was analyzed based on the theory of symbiosis. Descriptive analysis and intermittent time series segmented regression model were used to analyze the changes in indexes related to the flow of medical treatment and fund allocation between the leading hospital and primary institutions under the global budget.Results:The non-compact medical community′s symbiotic system had developed a continuous symbiotic model in organization and an asymmetric reciprocal symbiotic model in behavior. From the perspective of medical treatment flow, the number of outpatient and emergency visits of leading hospital and primary institutions in the medical community showed an upward trend, with little change in the number of discharged patients from 2017 to 2019; The number of patients transferred by the leading hospital increased from 32 in 2017 to 87 in 2019. According to the analysis of the intermittent time series segmented regression model, after the implementation of global budget, the proportion of outpatient and emergency visits in leading hospital was decreased ( β3=-0.43, P<0.05), the proportion of outpatient and emergency visits in primary institutions was on the rise ( β3= 0.02, P<0.05). In terms of fund allocation, the share of health insurance fund of the leading hospital increased from 45.98% in 2017 to 46.51% in 2019, and the primary medical and health institutions decreased from 23.44% to 18.06%, as well as the ratio of per capita income of primary medical and health institutions to that of leading hospitals was decreased from 72.62% to 60.79%. Conclusions:Under the global budget, the outpatient and emergency medical treatment flow in a non-compact medical community had been optimized. However, there was an uneven distribution of funds among medical institutions at all levels. Thus it was recommended to continue to give full play to the positive incentive effect of the global budget, establish a scientific mechanism for distributing benefits, and strengthen supervision and management.

Objective To analyze the influencing factors of post-operative delirium (POD) in middle-aged and elderly patients in intensive care unit (ICU) and construct risk prediction model for it.Methods A total of 112 middle-aged and elderly postoperative patients in the ICU of Lu'an Hospital of Anhui Medical University from January, 2018 to February, 2021 were selected. On the second day after the operation, they were transferred to ICU, and assessed with the Confusion AssessmentMethod for Intensive Care Unit (CAM-ICU). The patients were divided into delirium group (n = 52) and non-delirium group (n = 60) according to assessment. Univariate analysis was used to compare the differences in clinical data between the two groups, and multivariate Logistic regression analysis was used to screen the independent influencing factors to construct risk prediction model. Receiver operating characteristic (ROC) curve was used to evaluate prediction performance. Results Multivariate logistic regression analysis showed Acute Physiology and Chronic Health Evaluation II score (APACHE II score) (OR = 1.424, 95%CI 1.204 to 1.685, P < 0.001), ICU sleep quality score (OR = 1.432, 95%CI 1.159 to 1.770, P < 0.001), and postoperative oxygenation index ≤ 300 (OR = 4.485, 95%CI 1.644 to 12.240, P = 0.001) were independent influencing factors of postoperative delirium in ICU. The prediction model was: logit(P) = -11.381+0.354X1 (APACHE II score, cut-off value 16)+0.359X2 (ICU sleep quality score, cut-off value 13)+1.501X3 (postoperative oxygenation index ≤ 300), with the sensitivity and specificity of 79.2% and 79.7% respectively. The area under the ROC curve was 0.866 (95%CI 0.801 to 0.930), more than those of the factors alone (P < 0.05). Conclusion The prediction model based on Logistic regression can predict the occurrence of postoperative delirium in middle-aged and elderly patients in ICU.

The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.

Objective:To explore the risk factors affecting the occurrence of lower extremity deep venous thrombosis in patients with acute cerebral hemorrhage during intensive care unit (ICU) period.Methods:One hundred and thirty-five patients with acute cerebral hemorrhage who were transferred to ICU of our hospital from December 2016 to August 2019 were enrolled. The clinical data were collected, including gender, age, Glasgow coma scale (GCS) scores, hematoma volume, body mass index (BMI), systolic pressure, D-dimer, activated partial thromboplastin time, surgery before transfer, unplanned surgery during ICU period, and so on. According to occurrence of lower extremity deep venous thrombosis, these patients were divided into thrombosis group and non-thrombosis group; univariate analysis was used to compare the differences in clinical data between the two groups, and multivariate Logistic regression analysis was used to screen the independent risk factors for lower limb deep vein thrombosis, and the predictive efficacy was evaluated using receiver operating characteristic (ROC) curve.Results:Thirteen patients (9.63%) were diagnosed as having lower extremity deep venous thrombosis. There were statistical differences between two groups in GCS scores at admission, hematoma volume, BMI, D-dimer, platelet count, surgery before admission, unplanned surgery during ICU period, and hemostasis treatment ( P<0.05). Results of multivariate Logistic regression analysis showed that BMI, D-dimer, and unplanned surgery during ICU period were independent risk factors for lower extremity deep venous thrombosis ( OR=1.868, 95%CI: 1.147-3.043, P=0.012; OR=1.004, 95%CI: 1.000-1.008, P=0.037; OR=0.019, 95%CI: 0.001-0.446, P=0.014). ROC curve showed the area under the curve by combining these three factors was 0.982 ( P=0.000), with sensitivity of 92.31% and specificity of 96.72%. Conclusion:Acute cerebral hemorrhage patients with high BMI, high D-dimer level, and unplanned surgery during ICU period are more likely to have low extremity deep venous thrombosis during ICU period; these patients should be alerted in clinical process.

Objective: To observe the anatomical layers and important vascular structures in the main periorbital regions of the human body, and to provide some anatomical basis for clinical periorbital fat injection. Methods: During January 2018 to December 2018, 12 (24 sides) cadavers (6 males and 6 females, 47.5±11.7 years old) were selected. Their orbital tissues were dissected routinely and microdissected. The important blood vessels and tissues around the orbit were measured by electronic vernier caliper. The related matters needing attention in fat injection filling were analyzed according to references. Results: The main structural areas around the orbit included eyelid, eyebrow and lacrimal groove deformities. The thickness of eyelid skin was (0.09±0.03) mm. The thickness of eyebrow skin was (3.45±0.38) mm. Vascular (diameter ranged from 1 mm to 3 mm) distribution was abundant in this area. The inner diameter of dorsal nasal artery, supraorbital artery and trochlear artery were (0.73±0.42) mm, (0.88±0.37) mm and (0.71±0.51) mm respectively. Facial artery, maxillary artery and superficial temporal artery with internal diameters of (2.96±0.88) mm, (1.92±0.33) mm and (1.35±0.15) mm, respectively. Conclusions The entrance of upper eyelid injection is usually in the eyebrow tail or middle eyebrow, and fat is injected into the deep surface of orbicularis oculi muscle. The injection range is limited to the medial 2/3 of upper eyelid, the medial 1/3 of lower eyebrow and the lateral part of eyebrow. It is suggested that single layer microinjection of fat (0.5 ml to 1.5 ml) could be used. Lower eyelid fat transplantation is mainly used to correct deformities at the eyelid-cheek junction. The aim is to reduce the V-shaped deformity at the eyelid-cheek junction by increasing the fullness. Injection can be made by blunt needle into the inner, outer and middle part of the deformity. Fat can be injected into SOOF layer or periosteum in the palpebral and cheek sulcus area. The injection volume is 0.5-1.0 ml.